M ciwo na numfashi mai tsanani (ARDS): jagororin kula da haƙuri da magani

By Cristiano Antonino On Bari 10, 2023

“Ciwon Ciwon Hankali na Numfashi” (wanda aka gajarta tare da ma’anar ARDS) bisa ga ma’anar WHO (Hukumar Lafiya ta Duniya) “lalacewa ce ta alveolar capillaries wanda ke haifar da gazawar numfashi mai tsanani tare da hypoxemia arterial refractory ga gudanar da iskar oxygen”

ARDS saboda haka yanayi ne, wanda aka ƙaddara ta dalilai daban-daban, wanda ke nuna raguwar ƙwayar iskar oxygen a cikin jini, wanda ke da alaƙa da maganin O2, watau wannan maida hankali ba ya tashi bayan gudanar da iskar oxygen ga mai haƙuri.

Dole ne a bi da waɗannan cututtukan cikin gaggawa a cikin rukunin kulawa mai zurfi kuma, a cikin mafi munin yanayi, na iya haifar da mutuwar mai haƙuri.

ARDS na iya tasowa a cikin marasa lafiya na kowane zamani, waɗanda ke da nau'ikan cututtukan huhu iri-iri, ko a cikin batutuwa masu aikin huhu na yau da kullun.

Wani lokaci ana kiran wannan ciwo a matsayin manya na damuwa na numfashi, kodayake yana iya faruwa a cikin yara.

Mafi ƙarancin nau'in wannan ciwon ana kiransa "mƙar huhu rauni" (ALI). Game da majinyacin yara, ana kiran shi ciwon ciwon numfashi na jariri (NRDS).

Yanayi da cututtukan da ke haifar da farkon ARDS sune

nutsewa;
shaƙewa;
buri (shakar) abinci ko wasu kayan waje a cikin huhu;
tiyata ta hanyar jijiyoyin jini;
ƙonawa mai tsanani;
embolism na huhu;
namoniya;
ciwon huhu;
rauni na kai;
raunuka iri-iri;
radiation;
tsayin tsayi;
inhalation na iskar gas mai guba;
cututtuka da ƙwayoyin cuta, kwayoyin cuta ko fungi;
yawan shan kwayoyi ko wasu abubuwa, kamar su tabar heroin, methadone, propoxyphene, ko aspirin;
sepsis (cututtuka mai tsanani);
girgiza (tsawo mai tsanani mai tsanani hypotension);
canje-canje na jini;
matsalolin haihuwa (toxemia, amniotic embolism, postpartum endometritis);
toshewar lymph;
extracorporeal wurare dabam dabam;
pancreatitis;
bugun jini;
ciwon kai;
ƙarin jini fiye da raka'a 15 a cikin ɗan gajeren lokaci;
uremia.

Pathogenesis na ARDS

A cikin ARDS, ƙananan cavities na iska (alveoli) da capillaries na huhu sun lalace kuma jini da ruwa suna shiga cikin sarari tsakanin cavities na baka kuma, a ƙarshe, a cikin cavities da kansu.

A cikin ARDS akwai rashi ko raguwa na surfactant (wani ruwa wanda ke rufe saman alveoli na ciki kuma yana taimakawa wajen buɗe su), wanda ke da alhakin ƙara daidaiton huhu na ARDS: ƙarancin surfactant yana haifar da rushewar. yawancin alveoli (atelectasis).

Kasancewar ruwa a cikin alveoli da rugujewarsu suna tsoma baki tare da canja wurin iskar oxygen daga iskar da aka shaka zuwa jini, tare da raguwar matakin iskar oxygen na jini.

Canja wurin carbon dioxide daga jini zuwa iskar da aka fitar ba ta da rauni sosai, kuma matakan carbon dioxide na jini sun bambanta kaɗan.

ARDS yana siffanta ta

m farawa;
cututtukan huhu na huhu na biyu yana nuna alamar edema;
babu shaidar hawan jini na hagu (PCWP <18 mmHg);
Rabon PaO2/FiO2 <200.
Sharuɗɗa iri ɗaya, amma tare da ƙimar PaO2/FiO2 <300, ayyana mummunan rauni na huhu (ALI).

Alamomin ARDS sune

tachypnea (kara yawan numfashi);
dyspnoea (matsalolin numfashi tare da "yunwar iska");
crackles, hayaniyar hayaniya, tarwatsewar rales akan auscultation na huhu;
asthenia (rashin ƙarfi);
rashin lafiya gaba ɗaya;
shortness na numfashi, sauri da m;
gazawar numfashi;
cyanosis (bayyanar faci ko bluish discoloration akan fata);
yiwuwar rashin aiki na sauran gabobin;
tachycardia (ƙara bugun zuciya);
arrhythmias na zuciya;
rudani na tunani;
kasala;
hypoxia;
hypercapnia.

Wasu alamu na iya kasancewa dangane da cutar da ke haifar da ARDS.

ARDS yawanci yana tasowa a cikin sa'o'i 24-48 na raunin rauni ko yanayin etiological, amma zai iya faruwa bayan kwanaki 4-5.

ganewar asali

Bincike da ganewar asali sun dogara ne akan tarin bayanai (tarihin likitanci), gwajin jiki (musamman ciwon kirji), da sauran gwaje-gwajen dakin gwaje-gwaje da hoto daban-daban, kamar:

adadin jini;
nazarin iskar jini;
spirometry;
huhu bronchoscopy tare da biopsy;
kirji x-ray.

Rashin isashshen numfashi yana haifar da ɗimbin tarin fuka-fukan da ke bayyana akan x-ray na ƙirji da kamuwa da cuta akai-akai wanda ke haifar da mutuwa a sama da kashi 50% na lokuta.

A cikin m lokaci, huhu suna yaduwa da yawa, ja, cunkoso da nauyi, tare da yaduwa alveolar lalacewa (histologically, edema, hyaline membranes, m kumburi ana lura).

Ana ganin kasancewar ruwa a cikin wuraren da ya kamata a cika da iska.

A cikin lokaci na haɓakawa da tsari, wurare masu haɗuwa na fibrosis na interstitial tare da yaduwar nau'in pneumocytes na II sun bayyana.

Kwayoyin cututtuka sun kasance akai-akai a lokuta masu mutuwa. Binciken iskar jini yana nuna raguwar matakan iskar oxygen a cikin jini.

Bambancin ganewar asali ya haɗa da wasu cututtuka na numfashi da na zuciya kuma yana iya buƙatar wasu gwaje-gwaje, kamar electrocardiogram da duban dan tayi na zuciya.

Ciwon Matsala na Numfashi na Neonatal (NRDS)

Ana iya lura da NRDS a cikin 2.5-3% na yaran da aka shigar da su a Rukunin Kula da Yara na Yara.

Abubuwan da ke faruwa sun bambanta da shekarun haihuwa da nauyin haihuwa, watau cutar ta fi yawa fiye da yadda jarirai suke da wuri da rashin nauyi.

Ciwon jarirai yana siffanta da:

hypoxia;
yaduwa na huhu infiltrates a kan kirji X-ray;
matsa lamba na occlusion a cikin jijiya na huhu;
aikin zuciya na al'ada;
cyanosis (launi mai launin fata).

Idan an yi motsin numfashi tare da rufe baki, dole ne a yi zargin manyan abubuwan toshewa: dole ne a buɗe baki kuma a tsaftace kogon oropharyngeal daga ɓoye tare da fata mai laushi.

Mafi mahimmanci shine rigakafin rashin girma (ciki har da rashin yin wani sashe na caesarean wanda ba dole ba ko rashin lokaci), kula da yadda ya dace game da ciki mai haɗari da naƙuda, da tsinkaya da yiwuwar maganin rashin girma na huhu a cikin mahaifa.

Jiyya

Tun da a cikin 70% na lokuta mutuwar majiyyaci ba ta faruwa BA don gazawar numfashi ba amma don wasu matsalolin da suka danganci tushen dalilin (yawanci matsalolin tsarin tsarin da ke haifar da koda, hanta, gastrointestinal ko CNS lalacewa ko sepsis) maganin ya kamata a yi niyya:

samar da iskar oxygen don magance hypoxia;
kawar da tushen dalilin da ya haifar da ARDS.

Idan iskar oxygen da aka bayar ta hanyar abin rufe fuska ko ta hanci ba ta da tasiri wajen gyara ƙarancin iskar oxygen na jini (wanda ke faruwa sau da yawa), ko kuma idan ana buƙatar manyan allurai na iskar oxygen da ake buƙata, yakamata a yi amfani da iska. inji: kayan aiki na musamman yana isar da iskar oxygen a ƙarƙashin matsin lamba tare da bututu wanda, ta bakin, ana shigar da shi cikin trachea.

A cikin marasa lafiya na ARDS, abubuwan shigar da iska

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iska a ƙãra matsa lamba a lokacin wahayi;
iska a ƙananan matsa lamba a lokacin exhalation (wanda aka bayyana a matsayin matsi na ƙarshe na ƙarshe) wanda ke taimakawa wajen ci gaba da buɗe alveoli a lokacin ƙarshen ƙarewa.

Ana yin magani a cikin sashin kulawa mai zurfi

Gudanar da O2 ya tabbatar da cewa yana da amfani kawai a cikin matakan farko na ciwo, duk da haka ba ya kawo amfani a kan tsinkaye.

Endotracheal instillation na mahara allurai na exogenous surfactant a cikin ƙananan nauyi jarirai bukatar 30% oxygen da kuma taimaka samun iska: rayuwa yana ƙaruwa, amma ba ya rage yawan abin da ya faru na ciwon huhu na kullum.

Zaton ARDS: me za a yi?

Idan kuna zargin ARDS, kar ku ƙara jira kuma ku kai mutumin zuwa Sashen Gaggawa, ko tuntuɓi Lambar Gaggawa Guda: 112.

Hasashen da kuma mace-mace

Ba tare da ingantaccen magani da lokaci ba, ARDS abin takaici yana haifar da mutuwa a cikin 90% na marasa lafiya, duk da haka, tare da isasshen magani, kusan 75% na marasa lafiya suna rayuwa.

Abubuwan da ke shafar hasashen su ne:

shekarun marasa lafiya;
yanayin lafiyar marasa lafiya gabaɗaya;
comorbidity (kasancewar sauran cututtuka irin su hauhawar jini, kiba, ciwon sukari mellitus, cutar huhu mai tsanani);
iya amsawa ga magani;
taba taba;
saurin ganewar asali da shiga tsakani;
basirar ma'aikatan kiwon lafiya.

Marasa lafiya waɗanda ke amsawa da sauri ga jiyya sune waɗanda wataƙila ba kawai su rayu ba, amma kuma suna da ɗan ƙaramin lahani ko rashin lahani na huhu na dogon lokaci.

Marasa lafiya waɗanda ba sa amsa da sauri ga jiyya, suna buƙatar taimakon injin iska na dogon lokaci, kuma tsofaffi / masu rauni suna cikin haɗarin huhu da mutuwa.

Scarring na iya canza aikin huhu, gaskiyar da ta bayyana a fili tare da dyspnea da kuma gajiya mai sauƙi a ƙarƙashin ƙoƙari (a cikin ƙananan lokuta) ko ma a hutawa (a cikin mafi tsanani lokuta).

Yawancin marasa lafiya da ke da lalacewa na yau da kullum na iya samun asarar nauyi mai mahimmanci (raguwa a cikin nauyin jiki) da kuma sautin tsoka (raguwa a cikin% na ƙananan ƙwayar cuta) yayin rashin lafiya.

Gyarawa a cikin cibiyoyin gyarawa na musamman na iya zama da amfani matuƙa don samun ƙarfi da yancin kai yayin samun walwala.